Angela Stanton

12 December 2018

Your Questions: Hormone Changes before/during/after Menstrual Period

Thanks to Adrie from South Africa for this question about migraine attacks around the time of her menstrual period (ask your own question here!).

First, a quick definition, because it is important for treatment. There are two classes of migraine here. One is menstrually-related migraine. This is when attacks occur at least 2/3 of the time day -2 to +3 of your menstruation, but attacks also occur other times of the month.

woman writing — Keeping track of daily activities and symptoms is very important in menstrual migraine.

For the purpose of this question, however, we’ll focus on pure menstrual migraine, in which attacks occur 2/3 of the time day -2 to +3 of your cycle, but at no other time. (Here’s a summary of menstrual migraine in graphic form.)

There is no doubt that hormones are related to these attacks – but, surprisingly, just how they’re related is a bit of a mystery. The theory that we should simply be able to adjust hormone levels to solve the problem has not been the silver bullet.

Adrie is actually already a ways down the road searching for treatment, but hopefully we can help her or some other reader consider some options that haven’t been investigated fully. And remember, we’re speaking more generally anyway, because we will not diagnose a specific case here (even if we had enough information, which we don’t).

But first, the “treatment” that should not be tried – hysterectomy. Dr. Robert Cowan explains well in his book The Keeler Migraine Method:

In the past, doctors tried to modify this trigger through hysterectomy but today we know that hysterectomy will not improve migraines and can in fact make them significantly worse. Hysterectomy causes chaos in estrogen levels, estrogen receptors, and the chemicals that estrogen modifies. A migraineur’s brain does not like chaos. It likes things nice and regular and predictable.

So what are better options? Here are a few:

All-month Lifestyle: If certain things make your attacks worse, don’t fall into the trap of being careful only when the symptoms start. Even something you do days before can impact your symptoms. Are you eating properly? Getting enough sleep? A healthy diet and balanced lifestyle overall can improve things significantly.
Drug options: Taking an abortive even before the attack hits, or early on, can help you avoid the migraine monster. NSAIDs are commonly prescribed. One of the most helpful targeted migraine drugs is frovatriptan, taken twice a day for five days starting two days before you expect your menstrual cycle to begin. Here’s a quick summary of other medications.
Hormone Replacement Therapy: If I understood correctly, this is something Adrie is trying, but so far without success. This has helped many women, but again, it’s not the solution for everyone.
Contraceptive Changes: If you’re using a contraceptive that’s affecting your hormones, there are a number of options you could try, either to help narrow down what’s causing the problem, or to alleviate symptoms. For example, trying a low-estrogen pill, or investigating other forms of contraception.
Hydration: Dr. Angela Stanton, the “Queen of Hydration” thanks to her book Fighting the Migraine Epidemic, discusses in detail systems of hydration for migraineurs. Jumping of current research into the reason for menstrual migraine, she suggests that the female brain needs more “voltage” to run the menstrual cycle. Her suggestion (along with her full system that you can read about in the book) is to prepare 5 days ahead – no sugar, and more water (along with more salt). In her system, that would be an extra glass of water and an extra salt pill a day.
Preventative Medications: Preventative meds should be used cautiously with pure menstrual migraine, because they will affect your body 24-7, not just once a month. However, in severe cases, doctors may suggest a preventative.
Supplements: Adrie has tried some supplements without success. But some of the top ones include magnesium (and if one doesn’t work, try another – see Which Magnesium Supplements Work?) and vitamin E.
Other Treatments: If drugs can be avoided, or fewer drugs taken, that’s a better road to travel. Some excellent treatments include biofeedback, massage, deep breathing, and essential oils.

Final note: Keep a diary. Keeping track of your attacks is extremely important with menstrual migraine, even though you would think it isn’t. Some women find that, for example, when they give into a premenstrual craving, they make symptoms worse. Dr. Cowan, mentioned above, gives one story of a patient that illustrates well the need to keep track:

Partial triggers may show up in association with other triggers. For example, I had a patient who got her most severe headaches when she had her nails done during her period but not at other times. It took her about four months of journaling to pick this up. When she changed salons to a place that didn’t use heavy lacquers, she was fine.

Menstrual migraine is a difficult beast to fight (see 8 Reasons why Menstrual Migraine is “different”). But there are good solutions out there. Feel free to leave a comment, letting us know what has worked well for you!

5 November 2018

Snopes takes on Cream of Tartar for Migraine

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It’s not often that a Snopes article makes the rounds that is specifically focused on a migraine remedy, but the popular anti-myth site got some attention last month with a discussion of cream of tartar as a migraine remedy.

Admittedly, the article is bound to offend a wide crowd, discussing “the dubious malady of ‘MSG poisoning,'”, acid levels in the body, and even taking a jab at a popular health news site. But let’s take a look at the core issue – is cream of tartar a good migraine remedy?

What is cream of tartar? You may be familiar with cream of tartar as the white powdery substance used in baking. Baking soda actually contains cream of tartar. By itself, it’s often used to improve the look of things you’re cooking – this isn’t a cooking blog, so for a few tips, check out Cream of Tartar: What It Is and How to Use It.

But what is it? Joe Schwarcz PhD explains:

[Cream of tartar] is a byproduct of winemaking and remains behind as a sediment after fermentation. In chemical terms, it is potassium hydrogen tartrate which is basically partially neutralized tartaric acid.
[Cream of Tartar]

In everyday terms, let’s say this – cream of tartar is a mild acid in dry powdery form.

A search engine exploration will confirm that this is a “recommended” natural remedy (although now the Snopes article is pretty popular). And perhaps the last line in the Snopes article is key: “If the anecdotal reports of cream of tartar’s efficacy against headaches are real, it apparently works via a different mechanism than the ones proposed on the websites suggesting it to be a remedy.”

So what would that mechanism be?

As you might have guessed, cream of tartar is very high in potassium (of course, since it’s potassium hydrogen tartrate!). Potassium is very important in the body, regulating hydration and blood pressure, for example. In fact, in her popular book Fighting the Migraine Epidemic, Angela A. Stanton PhD advocates a system of hydrating the body with a balance of potassium and salt to fight migraine attacks.

But hold on – it’s not that simple. Although a daily recommended amount of potassium is by no means agreed upon, here’s an example – 4700mg/day (see High Potassium Eating). Now, a teaspoon of cream of tarter will give you 495mg of potassium – over 10% of your daily amount, and not far off from a cup of milk.

But taking that much potassium in powder form – or in a supplement – can be dangerous, and even trigger headaches and other symptoms. Why? because it messes with blood pressure.

Incidentally, a quick browse of popular potassium supplements show typical doses of far less than what a single teaspoon of cream of tartar would contain.

In spite of the fact that she advocates paying attention to potassium to fight migraine, Dr. Stanton warns against taking a potassium supplement:

I often receive the question if potassium should/could be supplemented in a pill form. The answer is no, you should not. Potassium is a dangerous mineral if too much is consumed (hyperkalemia) and if too little is consumed (hypokalemia). In both cases, if dietary changes don’t improve the condition, hospitalization is necessary. The harm in taking potassium as a supplement comes from the fact that it all absorbs at once. … Taken as a supplement by a migraineur, who normally has low blood pressure, it can cause fainting, palpitations, and potential heart damage, and may cause seizures. You are also likely to end up with a migraine.

She footnotes this discussion with various studies and discussions of how potassium actually works in the body.

So here’s the short answer: If your potassium is so low that you need such a high instant infusion of potassium, you have problems much more serious than slightly low potassium levels. You need to get to a doctor.

On the other hand, yes, potassium is important for migraine patients – but it should be taken the normal way, in normal foods, such as milk, spinach, avocado, and salmon. That way, the potassium absorbs normally.

By the way, don’t worry about the small amounts of cream of tartar that you typically use in cooking and baking. We’re talking here about taking it directly as a supplement.

Although the Snopes article was specifically responding to a discussion of MSG, migraine, and cream of tartar, the bottom line still seems to be that there are great sources of potassium you can make use of right now – but a teaspoon of cream of tartar isn’t one of them.

5 September 2018

Congratulations to our HeadWay Winners!

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Last month we celebrated 15 years of the free ezine, HeadWay! To celebrate, subscribers shared some of their best advice, and then four of them (chosen at random – thanks random.org) were sent a free book. So — who are the winners?

Congratulations to…

Zara from the USA
Muriel from Canada

You will both get a copy of Fighting The Migraine Epidemic: A Complete Guide: How To Treat & Prevent Migraines Without Medicine by Angela A Stanton Ph.D.

And, there are two more! Congrats also to…

Crystal from the USA
Sandra from Canada

You will both get a copy of The Migraine Miracle: A Sugar-Free, Gluten-Free, Ancestral Diet to Reduce Inflammation and Relieve Your Headaches for Good by Josh Turknett MD and Jenny Turknett.

Expect your books to arrive sometime before the end of September.

If you’re not a subscriber to HeadWay, just swing down to the bottom of this page.

Thanks to all who have been involved in the HeadWay community over the past few years!